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Disorders Flashcards

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0
Q

Difference between somatic symptom disorder & illness anxiety disorder

A

Somatic symptom disorder = anxiety about an illness with 1+ Sx

Illness anxiety disorder = Hypochondriasis; no symptoms

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1
Q

Criteria for adjustment disorder

A

Excessive distress within 3 months of identifiable stressor. Symptoms last less than 6 months.

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2
Q

Autism-Spectrum DSM-5 Criteria

A 
Social Deficits:
	-Social-Emotional reciprocity
	-Nonverbal communication
	-Developing & maintaining relationships
Restricted, repetitive behavior patterns:
	-Repetitive motor movements
	-Insistence on sameness or routine
	-Fixated interests
	-Adverse responses to sensory input

Occurs early in development & not better accounted for by intellectual impairment or other condition.

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3
Q

Prevalence of MDD: Women vs men

A

Women:Men = 2:1

Goes to 1:1 postmenopausal

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4
Q

Prevalence of MDD

A

15% lifetime

7% 12mo

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5
Q

Chances of having another MDE

A

1st episode - 50%
2nd episode - 75%
3rd episode - 95%

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6
Q

Average duration of MDE

A

8-18 months

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7
Q

What is the kindling theory?

A

With each episode of depression, more “kindling for the fire” - each subsequent episode can happen with weaker stressors.

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8
Q

What are the possible outcomes (graph) of depression?

A

Response (Acute phase)
Remission (Continuation phase)
Recovery (Maintenance phase)

Relapse if during continuation
Recurrence if during recovery

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9
Q

What is the typical initial treatment for MDD based on severity?

A

Mild/Moderate - respond equally well to medication & therapy

Severe - needs both medication & therapy +/- hospitalization

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10
Q

Substance-induced mood disorder criteria

A

1) Prominent mood disturbance
2) Evidence that it began soon after beginning substance/medication use & the substance is known to cause mood disturbance.
3) Not better explained by another depressive disorder
4) Does not occur exclusively during Delirium

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11
Q

What specifiers can be added to the MDD diagnosis?

A 
With anxious distress
With mixed features(some hypomanic symptoms)
With psychotic features
With melancholic features
With catatonia
With peripartum onset
With seasonal mood pattern
With atypical features
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12
Q

Criteria for melancholic depression

A

1) Prominent anhedonia
2) 3 or more of the following:
– Distinct quality of depressed mood
– Depression worse in the am
– Early am awakening ( 2hours before normal)
– Marked psychomotor agitation or retardation
– Significant weight loss
– Excessive or inappropriate guilt

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13
Q

How does depression present in elderly?

A

Irritability
Somatic complaints
Pseudodementia

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14
Q

How does MDD present in adolescents?

A

Behavioral changes
Changes in grades
Drug use
Change in friends

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15
Q

What are the monoamines?

A

5-HT
NE
Dopamine

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16
Q

What brain structures atrophy in depression?

A

Prefrontal cortex
Amygdala
Hippocampus

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17
Q

Medical conditions that mimic depression

A 
Pancreatic cancer
Hypo/Hyperthyroidism
Hypo/Hyperparathyroidism
Cushing's & Addison's
Anemia
Uremia
Pellegra
Dementias
Huntington's
Medications (Steroids, OCP's, Antipsychotics)
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18
Q

Criteria for MDD

A

5/9 of SIGECAPS
One of the 5 must be either depressed mood or anhedonia
Must be present for >2wks
Not better explained by another medical or psych illness

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19
Q

Criteria for Persistent Depressive Disorder

A

aka Dysthymia

A. Symptoms present for 2+ years (or 1+ years if child/adol.)
B. 2+ of the following symptoms present:
1. Poor appetite or overeating.
2. Insomnia or hypersomnia.
3. Low energy or fatigue.
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness.
C. Not better explained by another ilness

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20
Q

Features of PMDD (not criteria)

A

Mood la­bility
Irritability
Dysphoria
Anxiety symptoms

Occur repeatedly during the pre­-menstrual phase of the cycle and remit around the onset of menses or shortly thereafter.

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21
Q

Substance-Induce Mood Disorder criteria

A

Significant mood disturbance in which:
1 . The symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing SIMD.
3. Does not occur exclusively during delirium.

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22
Q

Depressive Disorder due to Another Medical Condition criteria

A

A. A prominent and persistent period of depressed mood or markedly diminished interest or pleasure in all, or almost all, activities that predominates in the clinical picture.

B. There is evidence from the H&P or labs that the disturbance is the direct pathophysiological consequence of another medical condi­tion.

Does not include depression 2/2 stress from having a medical condition. Depression must be a DIRECT consequence of the medical condition.

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23
Q

Atypical depression criteria

A

A. Mood reactivity (mood can brighten in response)
B. Two+ of the following:
1 . Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis
4. A long-standing pattern of interpersonal rejection sensitivity (not limited to epi­sodes of mood disturbance)

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24
Q

MDD with peripartum onset criteria

A

MDE during pregnancy or within 4 weeks postpartum

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25
Q

Indications for admitting an anorexic patient

A

Electrolyte disturbances
Bradycardia
Unstable vitals
Dehydration

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26
Q

When do DT’s occur?

A

2-4 days after last drink

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27
Q

What are the 1st & 2nd line treatment options for GAD?

A 
1st line:
	-CBT
	-SSRI's or SNRI's
2nd line:
	-Benzodiazepines
	-Buspirone
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28
Q

What are the mature defense mechanisms?

A

SASH

- Sublimation
- Altruism
- Suppression
- Humor
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29
Q

How long to continue bipolar maintenance therapy?

A

1st episode of mania - at least 1 year

2 or more episodes - lifetime

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30
Q

What psychiatric problems are seen in victims of sexual assault?

A

PTSD
MDD
Increased risk of suicide

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31
Q

What antidepressants are specifically indicated for treatment of OCD?

A 
Sertaline
Fluoxetine
Paroxetine
Fluvoxamine
Clomipramine (TCA; 2nd line)
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32
Q

What is the typical course of alcohol withdrawal?

A

6-24h - Mild withdrawal (anxiety, tremors, insomnia, sweating, GI)

12h-2d - Seizures & alcoholic hallucinosis

2d-4d - DT’s (autonomic instability, delirium)

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33
Q

Schizoaffective criteria

A

1) Multiple psychotic episodes with concurrent major depressive or manic symptoms
2) 2 or more weeks of psychosis without mood symptoms
3) Mood symptoms present for the majority of total illness
4) Not due to substances or other medical illness

#2 distinguishes from MDD or BAD with psychotic symptoms
#3 distinguishes from schizophrenia
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34
Q

Specifiers for persistent depressive syndrome

A

aka Dysthymia

1) With pure dysthymic syndrome - MDE criteria never fully met
2) With intermittent MDE’s
3) With persistent MDE’s (MDE criteria met for the 2y)

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35
Q

What are the Cluster B personality disorders?

A

Borderline
Antisocial
Histrionic
Narcissistic

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36
Q

Indications for ECT

A 
Severe/refractory depression
Depression in pregnancy
Refractory mania
NMS
Catatonic schizophrenia
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37
Q

ECT adverse effects

A 
Amnesia (anterograde & retrograde)
Seizures
Delirium
HA
Nausea
38
Q

Manic episode criteria

A

I) Elevated or irritable mood with increased energy or goal directed activity. Must be at least 1 week or any time if hospitalized.
II) 3 or more of DIG FAST:
-Distractibility
-Irresponsibility
-Grandiosity
-Flight of ideas
-Activity increased (goal-directed or sexual)
-Sleep decreased
-Talkativeness
III) Not better explained by another medical illness or substance

39
Q

Hypomanic episode criteria

A

I) Elevated or irritable mood with increased energy or goal directed activity. Lasts at least 4 days.
II) 3 or more of DIG FAST:
-Distractibility
-Irresponsibility
-Grandiosity
-Flight of ideas
-Activity increased (goal-directed or sexual)
-Sleep decreased
-Talkativeness
III) Not better explained by another medical illness or substance
IV) Episode is NOT severe enough to cause significant impairment, does not require hospitalization, & does not have psychotic symptoms.

40
Q

Difference between Bipolar I & Bipolar II

A

Bipolar I = manic episode +/- MDE

Bipolar II = Hypomanic episode + MDE

41
Q

What constitutes rapid cycling of bipolar disorder?

A

4 or more mood episodes in a year

Poor prognosis with rapid cycling.
Depakote is the drug of choice.

42
Q

Suicide risk in bipolar

A

35% of patients attempt suicide in both types

43
Q

Cyclothymic criteria

A

A. For at least 2y (1y for children/adolescents), multiple episodes resembling hypomania & depression, without ever meeting criteria for either.
B. During the above period, the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.
C. Criteria for a major depressive, manic, or hypomanic episode have never been met.
D. Can’t account for symptoms due to other medical illness or substance

44
Q

Substance/Medication Induced Bipolar Disorder criteria

A

A. A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with OR without depressed mood or anhedonia.
B. There is evidence from the H&P of both (1) and (2):
1 . The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Crite­rion A.
C. Symptoms not better explained by an independent disorder
D. Does not occur exclusively during delirium

45
Q

What are the negative symptoms seen in schizophrenia?

A 
Flat affect
Avolition
Anhedonia
Alogia (not speaking much)
Antisociality (not seeking out interaction)
46
Q

Time-course for schizophrenia spectrum disorders

A

Brief psychotic disorder = 1 day to 1 month

Schizophreniform = 1 month to 6 months
-Does not require a decline in functioning

Schiophrenia = 6 months or more of symptoms & 1 month or more of active phase psychosis

47
Q

Brief psychotic disorder criteria

A

A. Presence of one (or more) of the following symptoms. At least one of these must be
(1 ), (2), or (3):
1 . Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
B. More than 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
C. Not better explained by another mental/medical illness or substance

48
Q

Schizophreniform criteria

A

A. Two of the following present for >1 month but < 6 months (less than 1 month if successfully treated)
-Delusions.
-Hallucinations.
-Disorganized speech
-Grossly disorganized or catatonic behavior.
-Negative symptoms
B. If symptoms have not yet resolved but within this time frame, diagnosed as “provisional schizophreniform”
C. No manic or MDE during the period or have been present for <50% of the time.
D. Not due to a substance or other medical/psych illness

49
Q

Modifiers for schizophreniform

A

1) With good prognostic features: Two of the following present
- Good premorbid social & occupational function
- Onset of psychosis within 4 weeks of 1st noticeable change
- Absence of blunted affect
2) Without good prognostic features
3) With catatonia

50
Q

Schizophrenia criteria

A

A. Two of the following present for >1 month:
-Delusions.
-Hallucinations.
-Disorganized speech
-Grossly disorganized or catatonic behavior.
-Negative symptoms
B. Level of functioning (work, social, self-care) is markedly below prior achievement.
C. Meets A criteria for at least 1 month & has shown prodromal symptoms for at least 6 months.
D. No manic or MDE, or have been present for <50% of the time.
E. Not due to a substance or other medical/mental illness.

51
Q

Schizoaffective criteria

A

A. MDE or manic episode concurrent with Criterion A of schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood epi­sode (depressive or manic)
C. Symptoms that meet criteria for a major mood episode are present for >50% of the total duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance or another medical condition.

52
Q

Substance/Medication-induced psychotic disorder criteria

A

A. Presence of one or both of the following symptoms:
1. Delusions.
2. Hallucinations.
B. There is evidence from the H&P/labs of both
(1) and (2):
1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Crite­rion A.
C. Does not occur exclusively during delirium & not better accounted for by another condition

53
Q

Criteria for Borderline PD

A

A. Instability of relationships, self image, & impulsivity including 5 or more of the following 9:

- Impulsive
- Moody
- Paranoid or dissociative under stress
- Unstable self image
- Labile, intense relationships
- Suicidal
- Inappropriate anger 
- Vulnerable to abandonment
- Emptiness

Presents by early adulthood & present in multiple aspects of life.

54
Q

Histrionic PD criteria

A

5 or more of the following:

- Uncomfortable not being center of attention
- Inappropriate sexuality
- Rapid shifting, shallow emotions
- Uses physical appearance to draw attention
- Impressionistic speech, lacking in detail
- Dramatization of emotion
- Easily influenced by others
- Considers relationships more intimate than they are
55
Q

Chance of developing Bipolar:

  • General population
  • 1 parent has it
  • 2 parents have it
  • Identical twin has it
A

General population = 1%
1 Parent = 10%
2 Parents = 60%
Identical twin = 70%

56
Q

Treatment for conversion disorder

A

1) Education & self-help techniques

2) CBT

57
Q

What are the dopamine pathways & their effects?

A

Mesolimbic - Positive symptoms
Mesocortical - Negative & cognitive symptoms
Nigrostriatal - EPS
Tuberoinfundibular - Prolactin

58
Q

What is the ideal % of receptor blockade for antipsychotics?

A

65-80%

Less = not effective
More = SE's
59
Q

Longest half life of antipsychotics?

A

Abilify

60
Q

What is the typical response rate to antipsychotics?

A

70%

61
Q

How often to reassess response to anti-psychotic trial?

A

Every 4 weeks

If partial response –> increase dose
If no response –> next step in algorithm

62
Q

How long is an adequate trial for Clozapine?

A

4 weeks to titrate
12 weeks at therapeutic dose
Can give another 12 weeks at increased dose

63
Q

What percent of pts respond to Clozapine?

A

30-50% of previously treatment-resistant pts will respond

64
Q

Indications for Clozapine trial in schizophrenia

A

1) Recurrent suicidality or violence
2) Failed 2 other antipsychotics
3) Persistence of positive symptoms for >2y

65
Q

Who is most susceptive to TD?

A

Older pts

66
Q

Treatment for TD

A

1) Reduce antipsychotic dose or stop

2) Clozapine (50% of pts show 50% improvement)

67
Q

Risk of EPS across antipsychotics?

A

HP FGA > LP FGA > Risperidone > most SGA’s > Cloz & Olanz

68
Q

What is the advantage of Paliperidone?

A

Mostly renal excretion. Use in pts with liver disease

69
Q

Criteria for Panic Disorder

A

A. Recurrent, unexpected panic attacks
B. An attack is followed by at least 1 month of either:
-Persistent concern or worry about another attack
-Significant change in behavior to avoid attacks
C. Not secondary to a substance or medical condition

70
Q

Panic disorder:

- Women:Men
- Average age of onset
A

Women:Men = 2:1

Onset in late teens or 20’s

Higher risk of CVD & CVA

71
Q

Treatment for panic disorder

A

CBT (70%+ effectiveness)
SSRI’s/SNRI’s (1st line)
Benzodiazepines
TCA’s, MAOI’s

72
Q

Criteria for Agoraphobia

A

A. Marked fear or anxiety about 2 or more of the following:
-Public transportation
-Open spaces
-Enclosed spaces
-Crowds
-Being outside of home alone
B. Clinically sig. fear/anxiety & avoidance of these situations
C. Fear/anxiety/avoidance lasts 6mo or more

73
Q

Criteria for GAD

A 
A. Excessive anxiety/worry for 6mo or more
B. 3+ of following symptoms:
	-Restlessness, on-edge
	-Easily fatigued
	-Difficulty concentrating
	-Irritability
	-Muscle tension
	-Sleep disturbance
74
Q

GAD lifetime prevalence

Age of onset

A

Lifetime prevalence = 5%
Women > Men
Median age of onset = 31

75
Q

What anxiety disorder shows most comorbidity?

A

GAD

MDD = 62%
Substance = 38%
Social anciety = 35%

76
Q

PTSD components & duration

A

1) Re-experiencing
2) Avoidance
3) Negative alterations in mood
4) Hyperarousal

Symptoms present for at least 1mo

77
Q

Acute stress disorder criteria

A

A. Symptoms last 3 days-1mo

- Re-experiencing
- Avoidance
- Negative mood
- Hyperarousal
- Dissociative symptoms (not included in PTSD criteria)
78
Q

PTSD treatment

A 
CBT
Exposure therapy
SSRI's (1st line)
Prazosin (nightmares)
Clonidine/Propranolol (hyperarousal)
79
Q

OCD Criteria

A

A. Presence of obsessions, compulsions, or both

B. Obsessions & compulsions take >1h per day or impair function

80
Q

Treatment of OCD

A 
SSRI's (1st line; higher dosages needed)
Clomipramine (TCA)
SNRI's
CBT
Exposure & relapse prevention therapy
81
Q

Social anxiety disorder criteria

A

Fear/anxiety out of proportion in social situations or giving speeches

Must last 6mo or longer

82
Q

Specific phobia treatment

A

Systematic desensitization (exposure therapy)

83
Q

Drugs that can cause Serotonin Syndrome when mixed with SSRI’s

A 
Tramadol
Triptans
Linezolid
Ondansetron
Metoclopramide
MAOI's
84
Q

Treatment for serotonin syndrome

A

1) Stop the meds causing it

2) Cyproheptadine (5-HT antagonist)

85
Q

What are the Cluster A personality disorders?

A

Paranoid
Schizoid
Schizotypal

86
Q

What are the cluster C personality disorders?

A

OCPD
Avoidant
Dependent

87
Q

Treatment of PD’s

A

Psychotherapy (CBT & others)

Pharmacotherapy only for comorbid axis I disorders

88
Q

Delirium criteria

A

A. Disturbance of consciousness
B. Change in cognition
C. Develops over short period & fluctuates
D. Evidence that it is caused by physiological consequences of medical condition or substance

89
Q

Tests to get in delirium

A 
CBC, CMP, TSH, B12, NH4
UA, UDS
CXR
LP if indicated
Neuroimaging
90
Q

Antipsychotics used in delirium

A
  • Haldol
    • Risperidone
    • Quetiapine
    • Olanzapine
91
Q

Types of dementia

A

Alzheimer’s dementia
Lewy body dementia
Frontotemporal dementia
Vascular dementia

92
Q

Pharmacologic management of dementia

A 
AChE Inhibitors
	-Donepezil
	-Galantamine
AChE & BuChE Inhibitor
	-Rivastigmine
NMDA Antagonist
	-Memantine
93
Q

Causes of delirium

A

I WATCH DEATH

- Infection
- Withdrawal
- Abuse (substances)
- Trauma
- CNS pathology
- Hypoxia
- Deficiencies
- Endocrine
- Acute vascular/MI
- Toxins/drugs
- Heavy metals

Psych Clerkship (2 decks)

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